Provider Demographics
NPI:1053551796
Name:NORTH, PAMELA MARY (MD)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:MARY
Last Name:NORTH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3550 LEXINGTON AVE N
Mailing Address - Street 2:SUITE # 300A
Mailing Address - City:SHOREVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55126-8075
Mailing Address - Country:US
Mailing Address - Phone:651-295-7448
Mailing Address - Fax:
Practice Address - Street 1:3550 LEXINGTON AVE N
Practice Address - Street 2:SUITE # 300A
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126-8075
Practice Address - Country:US
Practice Address - Phone:651-295-7448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-20
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN29912261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health